Vaginal Dryness? Doctors Explain When To Use Lube, Moisturizer or Estrogen Cream
One eases friction, another soothes daily dryness and one treats underlying tissue changes
Key Takeaways
- Vaginal lube helps reduce friction during sex but doesn't treat everyday dryness.
- Vaginal moisturizers soothe daily dryness, while estrogen cream treats tissue changes.
- They can complement one another, but ask about application timing and safety with condoms
Ever since starting menopause, you’ve noticed a raw or burning sensation “down there,” or perhaps sex with your partner has gone from pleasurable to unbearable due to vaginal dryness. Through ads, commercials and even word of mouth, you’ve likely heard about everything from vaginal moisturizer to vaginal estrogen cream to lube promising to provide relief or make intimacy more enjoyable again. But what’s the difference, and when might you need each? We spoke to two top doctors to understand what you need to know about these three products everyone’s talking about.
Why vaginal dryness happens during menopause
Before we dive into the different products that can help with vaginal dryness, let’s have a refresher on what the condition actually is and where it could be coming from.
“Vaginal dryness means the tissue of the vagina and vulva doesn’t have enough natural moisture,” explains Karen Toubi, MD, board-certified ob-gyn and menopause specialist. “It can feel like burning, itching, rawness or pain with sex. Some women also get urinary symptoms like urgency, frequent trips to the bathroom, burning or frequent UTIs.”
Dr. Toubi says the most common cause stems from lower estrogen levels during menopause. “Estrogen keeps vaginal tissue thick, stretchy and well lubricated. When it drops, the tissue gets thinner, drier, less elastic and more fragile. That happens in the years leading up to menopause and after it.” Estrogen can also drop when a woman is breastfeeding or as a side effect of hormone blocking breast cancer therapies, adds Dr. Toubi.
How to treat vaginal dryness: Understanding your options
Vaginal estrogen cream, lube and vaginal moisturizers are certainly not the only methods to combat vaginal dryness. There’s estrogen pills, hormone patches, dietary changes like eating soy and even just spending more time on foreplay if vaginal dryness most impacts your sex life, to name a few. But many women hear a lot about these three topical solutions, so what is the difference exactly and who might benefit from each? Here’s what our experts had to say.
Vaginal lubricant
“Vaginal lubricants are over-the-counter, short-acting products intended strictly for situational use during sexual activity,” says Kathleen Jordan, MD, Midi Health’s chief medical officer and a Menopause Society-certified provider. Dr. Jordan says vaginal lube helps in the moment to provide immediate glide and lessen friction during sex, but it doesn’t alter vaginal tissue health.
Who may benefit: If you’re experiencing discomfort or friction during sex or even pelvic exams, regardless of whether you’re in menopause or not, vaginal lube could be a good fit, says Dr. Jordan. “They work best as an on-demand tool kept on the nightstand to ensure comfortable, pain-free penetration,” she continues.
Who may not be a good fit: “Lubricants are not a good fit for managing everyday symptoms of vaginal dryness, burning, itching or urinary urgency, as they wash away quickly and do not address the chronic underlying tissue changes associated with menopause,” adds Dr. Jordan.
Vaginal moisturizers
“Vaginal moisturizers are used on a regular, ongoing basis to trap moisture and soothe tissue, offering immediate relief from baseline discomfort throughout the day. And they can help address the dryness issue when used regularly,” explains Dr. Jordan.
Who may benefit: Dr. Jordan says those who would prefer a non-prescription approach or who are using a prescription approach but want fast relief from vaginal dryness while they wait for their prescription to take effect might be ideal candidates for vaginal moisturizers. “Vaginal moisturizers are a good fit for women seeking immediate, non-hormonal relief from mild, everyday dryness and friction during normal daily routines and will be able to incorporate a topical application into their regular routines,” adds Dr. Jordan.
Who may not be a good fit: While Dr. Jordan says vaginal moisturizers may offer some relief for mild dryness when used regularly, they’re not a great fit for all. “They are not the best fit as a standalone solution for women dealing with moderate-to-severe tissue atrophy, experiencing pain or even tearing with sex or recurrent urinary tract infections,” explains Dr. Jordan.
Vaginal estrogen cream
Dr. Jordan calls vaginal estrogen cream fundamentally different from both vaginal moisturizers and lube. “[Vaginal estrogen cream] is an FDA-approved, low-dose prescription medication that addresses the root hormonal cause,” continues Dr. Jordan. “Rather than simply coating the surface, it delivers a targeted, local dose of estradiol directly to the tissues, restoring natural elasticity, lining thickness, healthy pH and lubrication from the inside out.”
Who may benefit: Dr. Jordan calls vaginal estrogen treatments generally the “gold standard” for women with moderate-to-severe GSM symptoms such as persistent burning, dryness, pain with intercourse and UTIs. “The most commonly used is a vaginal estrogen cream that can be obtained from most pharmacies with a prescription—it’s easy to use, generic and covered by most insurances,” adds Dr. Jordan. “There are also other vaginal estrogen options such as prescription vaginal tablets and flexible, slow-release medicated rings that can be inserted if other formulations are desired.”
Dr. Jordan says that vaginal estrogen cream is covered widely by insurance and can range in cost from $8 to $35 if you pay for it out of pocket.
Who may not be a good fit: Women who don’t particularly enjoy the messiness or variable dosing involved with using a cream manually might not be a great fit for vaginal estrogen cream, says Dr. Jordan. “Those patients often do better with fixed-dose vaginal tablets or a 90-day ring,” she continues.
“Additionally, any woman with unexplained, undiagnosed vaginal bleeding must be clinically evaluated before starting therapy, and breast cancer survivors actively taking aromatase inhibitors should always coordinate care with their oncology team,” adds Dr. Jordan.
Can you use these products together for vaginal dryness?
If you fit multiple descriptions for who could use these products and want to give more than one a try, Dr. Jordan confirms that, for the most part, you can.
“These products can safely and effectively be used together as complementary therapies,” explains Dr. Jordan. “A patient can use low-dose prescription vaginal estrogen as her foundational medical treatment to rebuild mucosal health, apply a non-hormonal vaginal moisturizer for day-to-day comfort and keep a water-based lubricant on hand for sexual activity.”
Still, if you’re going to use multiple options at the same time, you want to go about it the right way. “You should avoid applying a vaginal moisturizer at the exact same time as your prescription estrogen cream,” adds Dr. Jordan. “Layering a heavy moisturizer simultaneously can create a physical barrier on the tissue that prevents the active hormone from absorbing properly. It is best to stagger them: applying your prescribed estrogen cream at bedtime on its designated schedule and using moisturizers on alternate nights or during the day.”
And Dr. Toubi flags some considerations for sex and contraceptives. “Oil-based lubricants weaken latex condoms and raise the chance of breakage,” says Dr. Toubi. “Use water-based or silicone-based lube with condoms. And if you use sex toys, check the toy maker’s guidance on which lube is safe for the material.”
As always, if using any of these products causes irritation or vaginal bleeding, seek medical treatment, advises Dr. Jordan.
The bottom line on treating vaginal dryness
Whether vaginal dryness has turned moments meant for connection with your partner into moments of dread or is simply making your days uncomfortable, you don’t have to just live with it. There are plenty of products and options available. A quick conversation with your doctor can help you find what works best for you. As Dr. Toubi says, “You deserve to feel comfortable in your body.”
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